Tuesday, August 17, 2010

Peptic ulcers notwithstanding

Much like I feel like I deserve an award for bringing my two young children to IKEA and returning home with the same two children, so do I for finishing my 15th letter of recommendation for fourth-year medical students each Fall.  Sure, some letters are easy:  those whom I know well and can share insightful anecdotes about basically write themselves.  But, then there are the students who I know less well, or worse, have reservations about, where the objective is to write the most positive letter I can without lying. After writing fifteen letters, it’s hard to sound fresh and engaging. I’m just hoping to use the correct pronouns consistently.(1) Then, after I send that last letter off to the Dean’s office, I’m left looking around for the man with the medal who is supposed to say, “Thank you for your service, Ma’am. Here’s that medal I promised you.”

Like being a mother, being a clinician-educator is full of thankless tasks.  There are no trophies for remembering to buy enough diapers so your child doesn’t have to wear swim diapers (again). There are no engraved plaques for having a one-hour feedback session with a student who is not performing at an acceptable level, but doesn’t agree with that assessment. There’s not even a blue ribbon for winning first prize in “Guess what this abstract finger painting is of (Hint: not your first instinct),” or “Pin down the last evasive attending that needs to give their input before the final grade computation.”

Yet, I’ve also found that, like mothering, being an educator means you do these thankless tasks out of love. Because your job and who you are is why you do what you do. You know that they will grow up and, at some point, hopefully, appreciate the time, the patience, and the energy you put into everyday. And, even if they don’t ever say “Thank you for ruining your body forever by having me,” or “Your investment in me made me a better doctor,” deep down inside you know you made a difference.

The labor of love that is parenting and educating is one and the same: at times painful, occasionally the cause of a peptic ulcer, but, in the end, unbelievably rewarding.

Still, more awards (or medals) for both jobs would be nice. A girl can dream.

(1) NB: some to all parts of this post are written tongue-in-cheek. Please do not send hate mail or actual medals.


  1. Elaine Schattner, M.D.August 17, 2010 at 8:03 AM

    Nice post. What strikes me is that 15 students asked you to write letters. That sounds like a lot.
    What I wonder (read: doubt) is if your male colleagues are doing the same.

    When I was working full-time, I wrote many recommendation letters for students, fellows and junior faculty. In retrospect, I wish I'd spent more of my time on grant applications, research publications or else, even better, getting home for dinner on time.

    There's no end to how many people you can help, students included.

  2. Yes, there should definitely be more medals in life.

  3. This post is interesting to me in light of my current desperate, manic requests for Letters of Rec. If I may represent the entire fourth year class in the U.S., THANK YOU for taking the time to help us, especially when the letters are personal and genuine. I hope to remember this feeling of terror and "What if they don't like me" when I am all grown up and writing the letters instead of begging for them.

  4. It's hard for me to read this, and not be reminded of the not terribly helpful feedback I received on some of my rotations, and of the very useful feedback that I received on others. I'm sorry we students don't always take your constructive criticism the way in which you want us to. It's not an easy thing to do, which I'm sure you know. I'm sure I must have frustrated some of my attendings who were "trying to help" but gave me advice that I just couldn't put into action they way they wanted. Sometimes I felt that no matter how hard I tried I couldn't please some of my them. That was very frustrating to me, as I'm sure it was for them. They probably thought I was ignoring them too. I guess ultimately one just has to accept that some people aren't going to click with you, and your advice will fly by them simply because you don't understand one another. Also, sometimes people just aren't at the stage where they are ready for the advice that they're given. And finally, sometimes the advice isn't delivered in a way that is actionable.

    Thank you for all your efforts with your students. I'm sure they are appreciated by the students, even if it doesn't always seem like it.

  5. I second the thanks from the 4th year medical student class! I too am a 4th year medical student in the throes of procuring Letters of Recommendation (and it is capitalized because it is that important!) I would love to do something small for those faculty members who are writing for me, but have no idea how to do that and stay within the bounds of an appropriate student-faculty relationship. Any ideas? Thanks so much!

  6. To commenter Rinda (above) and the other 4th yrs:
    I'd say just a sincere expression of thanks (i.e. no gifts just saying thank you) and maybe let us know how you are doing down the road! How the match turns out, how internship is going, how your career turns out... We really do want success for you all.

  7. We are sisters under the skin! It is sometimes hard for students and for us to remember that in the end we do it for love. The more we measure "outcomes", the less we just appreciate and value. Ah well.

  8. Elaine - 15, like all other parts of this post, was probably an exaggeration. It feels like 15. Maybe my actual record is 10. It is part of my job, though. I wouldn't want any less. I write awesome letters!

    Kyla - yes, I think I'm due for one for surviving the Terrible Two's without sending my toddler to military boarding school.

    Katie- I felt the same insecurity when I was applying and while this post was poking humor at the whole process, know that we all (like fellow educator T said above) sincerely want every student to succeed and write THE best letter humanly possible for them. We do it out of love.

    OldMDGirl - thanks for that perspective, and yes, I have been the receiver of useless feedback in the past - certainly frustrating. I should have mentioned that I am clerkship director of the medicine clerkship and have to sit down with students who are in danger (by assessment of their ward teams) of failing the clinical part of their rotation. This is never an easy conversation but hopefully, can result in them being able to appreciate what they need to do to improve and pass the course. It's a difficult conversation for me when the reaction is disbelief/denial. Understood, but difficult. That aside, I've found that students are wonderfully receptive of feedback, thirsty for it, really, and take off running with it. That is a reward in itself.

    Rinda- completely agree with T. An expression of thanks, let us know where you match! And I've loved getting emails from prior students during their residency to let me know how they are doing. It makes my day.

    T-thanks for jumping in there.

    juliaink - yes! It is so like mothering - the "medals" come in everyday forms, disguised as the joy of a child jumping into a swimming pool, in watching a student present a poster at a conference...

  9. Today I got back a note from my first fellow. She is doing really well in her job and is also a great human being.I had a little to do the the former but the latter is why I stay in academics, in spite of the letters to write when I really should be doing my grant/paper or seeing my kids. So fourth years the best thanks is to go out and be the good doctors we think you are going to be and then touch base with what you have done.

  10. I am not a medical student, but just a nurse and I cannot say how thankful I am for those attendings, residents and fellows who educate us nurses even though no one is requiring them to do that. So, thank you! Your time is not wasted.

  11. Anonymous- those letters are the best. Completely agree. Like mothering - I want my children to be happy, productive adults but also to call and update me frequently!

    K- thanks for your comment. We're all part of the same care system and the opposite is entirely true- all that I've learned from nurses is immeasurable. (thinking back especially to my intern year - wow)

  12. As a clinician educator, trying to finish her M.Ed (on formative assessment and feedback, ironically) while raising a 2 year old, I would really, really like to give you a medal.



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